An open stairway climbs the outside back wall of a church in the village of Lorie, in rural northern Haiti. It leads to a low abutting roof, a gap in mason covered wood slats, and a view into the church.
The photograph below looks in from behind the pulpit, and across the nave and pews. The furthest point is the front door. The day before people filled the sanctuary to pray. This day the area has been transformed into a medical clinic.
Over the past 8 years, the Haitian Caribbean American Organization of Texas (HACAOT) has brought a team of doctors and medical professionals to Haiti every November, to run a mobile health clinic and treat the medically disenfranchised. They stay in a house in the northern city of Cap Haitian. Each morning they leave at dawn, travel to an area in need, and set up a full functioning healthcare clinic. They work non-stop until dusk, pack up, go home, and do it over again the next morning. Typically, 250-300 patients are seen each day.
Look down, then along to the right of the first photo. Everything from the pulpit to the back wall is a well-stocked pharmacy, staffed by three. Each bucket is filled with different medications. In the lower left is the hydration area, round orange coolers filled with Gatorade. Down the left wall is a lab area, and beyond are triage stations. Past the stage on the right are three doctor stations. Check-in is at the far back, where patients enter through the secure front door of the church.
On this day the crew arrived at 7:15 am. The first patient was with a doctor by 7:36 am. Within 90 minutes, all free space beyond the pharmacy was filled with people. It was non-stop all day until closing, just before sunset, due to lack of electricity.
Each morning when the team reaches their location, it’s not uncommon to have a two hundred or more people waiting. By mid-morning the crowd will swell to double, maybe triple. Those fortunate to be seen are first checked in, then go through triage. A medical history is taken and vital signs are measured; pulse, blood pressure, temperature, O2 saturation, and weight. Then they’re directed to the appropriate doctor to for an examination.
The team sees a wide variety of patients, and the crowd is continually scanned for critical cases. This woman was found slumped against at tree and rushed into the clinic on a stretcher. She was suffering from severe dehydration and low blood sugar. An IV was started immediately, and she rested for the remainder of the morning. By afternoon, she was strong enough to walk home on her own.
Exams begin by going over intake information with the patient and asking relevant follow up questions to better understand their needs. Eye problems are common in older patients. They can be a basic as the need for glasses, to more serious issues of cataracts, glaucoma, keratitis, macular degeneration, and blindness.
The elderly, and infants with their families, are given preference to be taken first into the clinic. In this photo, medical team lead Mary Fargen is treating an infant for a sprain. With help from her assistant Chris, they carefully bandage her wrist. When the procedure was finished, she settled into the comfort of her mother’s arms.
Healthcare isn’t available for many people in Haiti, and these clinics are frequently their only chance to see a medical professional. Dehydration, respiratory problems, gastro-intestinal ailments, infections and malnutrition are among the most common medical issues. High blood pressure, high cholesterol, and diabetes is also seen in many older patients.
Out of desperation, it’s not uncommon for baby who has already been seen to be given to a relative or friend outside the clinic so they can have a chance to get in too – understandable given the dire situation of the population. The check in area needs to remain alert so limited resources aren’t used on the same baby twice.
On the first day of clinic, November 2011, an infant girl with labored breathing was brought in to see a doctor (photo right). She had a severe irregular heart beat and was immediately rushed to the hospital in Cap Haitian. Mary went over the case information with the hospital medical staff and the prognosis was not good. Without donor assistance to transport her for surgery at a modern medical facility, she would probably die. What happened later is unknown.
On the last day of clinic, November 2011, a five year old boy in respiratory failure was rushed to the doctors (below left). Beginning with a nebulizer, they worked for two hours to stabilize him, then took him directly to the hospital. That evening during our daily debriefing, the doctors were skeptical about his prognosis. The team left for the U.S. the next day.
A year later, November 2012, a mother with a small child came in asking to see Doctor Mary. “I’ve been looking for you all morning and that’s why I came here, to say thank you. You saved my son’s life,” she said. It was the same boy who had been treated the prior year. His name is John and he fully recovered. Mary reexamined him and there were no signs of respiratory problems (above right). It was a tearful reunion with the medical team.
Infections and abscesses are common problems, as seen in the right armpit of this 12 year old girl (photo left). She came to the clinic on her own. With a local anesthetic, the medical team opened and drained her abscess. Seen here after the procedure, she rests before being bandaged and sent home. The next day she returned for a follow up and to have her dressings changed.
When examinations indicate the need for further tests, patients are directed to the lab area. A urinalysis test strip (below right) can detect signs of infections, kidney and liver disease, diabetes, and other health conditions. Blood and urine samples can also be used to test for pregnancy, malaria, HIV/AIDS, anemia, hepatitis, lung disease and typhus.
Most of the patients end their clinic visit at the pharmacy. When medications are given out it’s important that the patient understands what to take and when. In this case, a simple drawing (below left) reminds the patient to take one pill in the morning (sunrise), and another in the evening (sunset). When leaving, donated articles such as clothing, baby bottles, soap, tooth brushes and tooth paste are also handed out while supplies last.
Copyright 2012 Adam Bacher. All rights Reserved – Absolutely NO usage without prior authorization.